Seeking Advice: Direct Entry Blues

Specialties NP

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I am a graduate of direct entry accelerated BSN/MSN program for non nurses.

I came into the role of APN, specifically NP as a very green graduate. I did very well in my program, but am finding clinical practice as an APN to be quite challenging. Academic knowledge and clinical expertise are very different. I've been in my present position about a year and have been directed to seek a position elsewhere but permitted to continue working while I search. It was also mentioned I try to seek a specialty area instead of primary care so I can focus my knowledge development.

I'm looking at specialties but wondering about my best options on where to go from here. I am not against applying to bedside RN positions. I've worked so hard but have wondered about leaving nursing altogether for something else.

Any guidance appreciated

I am so sorry that you have had this experience. I was also a "direct entry" NP. I took time after graduating and taking my boards to work in the ED as an RN ( I had previous EMS experience). It was a great decision for me, for personal reasons. I started working as an NP in a specialty about a year after that. I had reached a point where although I loved working as an RN, I was really ready to put my degree to use. My RN experience is helpful in my current work, but it's not essential. My classmates have all done well without having RN experience. I think transitioning back to a bedside role would be very difficult, especially after you have been the one writing the orders! If you miss RN skills, flu clinics and volunteer health screenings for your community can be very fun! Best of luck, and hang in there!!

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Thank you all for your feedback.

I am definitely interested in residency programs and open to pursuing a specialty that would provide intensive training. I also like the idea of focusing my content development and becoming an expert in one area. The specialties I'm most interested in are ortho and developmental peds but not unwillingly to consider another specialty.

As far as bedside nursing, it seems like it might be difficult to enter at this point given my circumstances for many reasons (including I'd want to be in the same training as a new grad and that might not be possible) though I still will apply.

Alternatively, I've always enjoyed research but not sure I how to get into the field from a nursing perspective.

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Specializes in Adult primary care, Medical/surgical, burns, ICU.

I'm having a hard time understanding why my bedside nursing experience has no crossover to primary care NP practice. As a current NP student, I have finding my RN experience invaluable in the NP clinical portion of the program. I have listened to thousands of hearts, bellys, and sets of lungs. I have analyzed countless lab results. I have been exposed to hundreds of diagnoses that I will see in the primary care setting. I know what uncontrolled chronic illness looks like in the acute setting. No, I dont prescribe metformin, glipizide, or insulin. But I have administered them countless times. They key here is exposure. No, I'm not writing prescriptions or billing for visits, but the thousands of patients in my care for acute illness also have comorbid conditions managed in the primary care setting. While they are inpatient, who administers their home medications that were prescribed in primary care? Me! This in itself have been pivitol in understanding dosing, monitoring, adverse effects, and implications as an NP student.

My comment is not to bash direct entry grads. It is to defend the fact that my RN experience DOES serve a purpose as an NP. RN experience is a building block that is foundational to NP practice. It is what the concept of an advanced practice nurse was developed on.

As far as advice, I think you need to sit down with your supervising physician and really nail down what you need to work on. You need to take this advice into the search for a new NP job in which you will he supported. You will he successful. Going to the bedside does not make sense at this point because you would be starting from square one as an RN new grad.

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Specializes in Peri-op/Sub-Acute ANP.
Not putting words in Jules' mouth but speaking for myself, I don't think "perform(ing) on the same level as a seasoned professional" is a realistic expectation of a new grad, but I think that a minimum level of basic competence is.

If the nursing profession is going to take the position that it's reasonable for new graduate NPs to need extensive, intensive orientation, I think that is going to harm the NP profession over time, employment-wise, against PAs and I also think that it is further enabling the low-quality schools to continue to crank out poorly prepared clinicians with no adverse consequences (for the school, that is).

It doesn't sound to me like they are letting her go because she does not meet a minimum level of basic competence. If you read her OP, they are allowing her to stay for several "months" while she finds a new position. Please, nobody is that nice. She works with peds. I doubt they would assume the legal responsibility of having someone who was endangering patients to continue to work for them. She would be gone! If I had to guess, she just isn't making them enough money. She is likely making enough to cover her salary - or again, she would be gone - but they are not seeing her speed up enough for them to be able to project that she will meet their anticipated profit.

While I don't disagree that more training and experience is needed, there is something being missed in this instance and I'm not sure that her "competence" is what is at the heart of the decision to let her go.

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I would wonder what would happen if OP improved to their expectations during the coming months. That should be her goal in addition to finding a new position.

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Hello,

You ARE an NP - you are just not an experienced NP, that will only come with time and training. Stick with what you love, and find a place that will support you with the skill set you have and help you grow.

I do not know where you live, but I do know that there is a serious shortage of Dev Peds providers. In my area there is a post-graduate LEND fellowship program that is accepting applications and provides additional training in this specialty, they seek people for clinical and research positions. LEND is a national program and may be worthwhile to look into.

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It doesn't sound to me like they are letting her go because she does not meet a minimum level of basic competence. If you read her OP, they are allowing her to stay for several "months" while she finds a new position. Please, nobody is that nice. She works with peds. I doubt they would assume the legal responsibility of having someone who was endangering patients to continue to work for them. She would be gone! If I had to guess, she just isn't making them enough money. She is likely making enough to cover her salary - or again, she would be gone - but they are not seeing her speed up enough for them to be able to project that she will meet their anticipated profit.

While I don't disagree that more training and experience is needed, there is something being missed in this instance and I'm not sure that her "competence" is what is at the heart of the decision to let her go.

I was not commenting on or referring to the OP's situation specifically; I was responding generally to the comment made by another poster, which I quoted in my post (that you quoted).

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Specializes in ICU, LTACH, Internal Medicine.
I'm having a hard time understanding why my bedside nursing experience has no crossover to primary care NP practice. As a current NP student, I have finding my RN experience invaluable in the NP clinical portion of the program. I have listened to thousands of hearts, bellys, and sets of lungs. I have analyzed countless lab results. I have been exposed to hundreds of diagnoses that I will see in the primary care setting. I know what uncontrolled chronic illness looks like in the acute setting. No, I dont prescribe metformin, glipizide, or insulin. But I have administered them countless times. They key here is exposure. No, I'm not writing prescriptions or billing for visits, but the thousands of patients in my care for acute illness also have comorbid conditions managed in the primary care setting. While they are inpatient, who administers their home medications that were prescribed in primary care? Me! This in itself have been pivitol in understanding dosing, monitoring, adverse effects, and implications as an NP student.

Count your blessings if your workplace allows you to do NURSING job and develop skills. In my NP class there were several students who worked in a teaching hospital where nurses were not allowed to check blood sugar or apply pulse ox without an order and had "limit" of one lungs assessment/shift - in a step down cardio unit, because some "customers" (read: patients who just made it ftom CVICU to tele floor) complained that deep breathing hurt. In some units there RNs were "discouraged" from wearing stetoscopes because "it could confuse customers".

Those guys had the whole long way more problems than the rest of us while in NP program. I tried not to discuss my unit in their presence, because where I was bedside nurses could, after informing charge nurse, order a bunch of STAT labs, 12-leads and ABGs and even get and administer limited number of "emergency" meds.

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I am so glad to see this post. I am a career changer and actually have applied to an ~eight month direct entry ABSN+MSN Program. Reading this is so insightful, because your experience has been a fear in the back of my mind.

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There have actually been studies that have shown prior RN experience has no impact on transition to the NP role after graduating. What does have an impact is a formal orientation provided by the employer. Sounds like this situation was more related to a bad employer-employee fit, not a lack of RN experience. Also to the people who want to slam anyone in a direct entry MSN program, many of us could not afford a second Bachelors degree (the government doesn't give you aid for that twice), so think twice before immediately assuming that everyone in a direct entry program just wants an easy way out.

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Also another thing to keep in mind. Direct entry programs ARE NOT created equal. Some programs are almost entirely online, for profit, and designed to crank out NPs with no clinical skills as fast as possible. There are many direct entry programs that are incredibly intensive and require thousands of clinical hours in addition to class time.

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Specializes in Nephrology, Cardiology, ER, ICU.
I am so glad to see this post. I am a career changer and actually have applied to an ~eight month direct entry ABSN+MSN Program. Reading this is so insightful, because your experience has been a fear in the back of my mind.

8 months long from BSN to MSN NP!!!!!! Wow! How do you fit all your clinicals and the core classes in in 8 months?

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